AIDS IN AFRICA: The Lazarus Effect

Uganda's capital, Kampala, is a city of more than a million people sprawled across the hills north of Lake Victoria. Central Kampala is busy and prosperous, with hotels and shops, embassies and—everywhere—the white, new SUVs of nongovernmental organizations (NGOs) emblazoned with acronyms that mostly include an "A" for AIDS. But go to the outlying districts and you are in another world: endless dirt-road slums with huts built of cast-off lumber, mud, and corrugated steel, no running water, and no sign of the NGOs or the assistance they've come to bring. One of the most desperate of these slums is Kabalagala.

On a Sunday morning at Pastor Paddy Luzige's New Life Church in Kabalagala, the congregation is made up disproportionately of children, many of them robbed of their parents by AIDS. More than 3,000 of the district's 16,000 residents are orphans, and Luzige, who with his wife Rose has adopted nine orphans, watches as group after group toddles in, the older children leading the brothers and sisters who have been left in their care. He seems to know them all by name.

Baylor College of Medicine's Sue Kelly, along with the pediatric ward staff at Mulago Hospital and a patient

The sermon today is about faith, and Luzige takes his text not from the Bible but from the clinic. He tells a story: Two people went for an HIV test. One was HIV positive, the other negative, but the clinic mixed up the test results. The man who was HIV-negative was told he was positive. He was devastated, lost his faith, and died. The other lived for a long time.

The rest of the service swells with joy and song, and many in the congregation linger long after the service is over. When they are gone, Luzige talks more about faith. With millions in Africa dying of AIDS—2.2 million in 2003, according to the Joint United Nations Program on HIV/AIDS (UNAIDS)—faith in God is all these people have.

A nurse dispenses medicines at a private clinic

What about treatment? What about the NGOs? What about drugs? Luzige gestures down the dusty streets, where the orphaned children gather. "There are no patients on AIDS drugs here."

It wasn't long ago when the same thing could be said almost anywhere in Africa. For people who work with AIDS in Africa, the change that occurs when drugs arrive has been almost miraculous. "When I came here in 2003, it felt like I was going back in time to the pre-protease inhibitor era," says Sue Kelly, lead project coordinator of the Baylor College of Medicine Pediatric AIDS Initiative at Mulago Hospital, the country's leading medical center. In those days, Mulago's pediatric AIDS clinic, formerly called Ward 15, operated one day a week out of a tiny, windowless room. There were four clinicians, but little they could do beyond watching children die. "Very, very few people in the entire country were on ARV [antiretroviral] treatment," says Kelly. "So it was just rooms full of very sick children here at the national public hospital. And now, we have been seeing people come back to life."

The Kabalagala Boys Choir educate audiences about AIDS prevention through song and dance

Many things count in controlling the AIDS epidemic. Diagnosis, education, and prevention are all crucial. But to achieve the transition Kelly describes, from watching people die to seeing them return to life, it takes drugs. And getting AIDS drugs to Africa, where patients are poor and the number of cases is unimaginably vast, is one of the great medical challenges of our time.